CBT for Depression: Mood and Thought Diary

Last week I started therapy for my depression and ADD.  If therapy for ADD sounds strange, allow me to say that it's always been a huge factor in my depression.  When you grow up with any sort of neurological difference, your self-esteem is systematically crushed into a pulp; you're told that you're not "really" trying, that you don't care enough to learn, that you could do so much better if you just "worked up to your full potential".

It's that last one that really got to me.  I was told repeatedly by my parents and teachers that I was "too smart" to be sucking in school as much as I was.  I didn't feel like I was smart at all.  If I was so damn smart, why was school so hard?  Why couldn't I remember a word the teacher said?  Why couldn't I finish my assignments?  Why wouldn't they all realize that I was just plain dumb and leave me alone?

Growing up like that plants a lot of negative thoughts in your head.  The thought and mood diary that my therapist assigned me to do last week has really brought that out into the light.  I learned that sometimes my thoughts precede my mood, and sometimes my mood precedes my thoughts, but that whatever the situation holy crap am I a negative person!

Worn Out, OR: Gotta Have Heart

I am officially sick of taking care of myself.

Why bother to limit my alcohol intake?  Why should I avoid sugar and caffeine?  Why make the effort to exercise?  I worked so hard to instill these habits four years ago because I wanted to get healthy.  And where has it gotten me?

Fuck-all nowhere.

OK, it worked for awhile.  I lost 60 lbs.  I got in shape.  I got organized.  Let me say that again: I, that is to say, Addy Bell, got organized.  If you'd seen my report cards from elementary school you'd know what a miraculous feat that is.  Anyway, as a result of working my ass off, my depression lessened, my ADHD symptoms improved, and I felt better than I had in years.  For the first time in my life, I was in control.

That is, until I wasn't.  Until I went nuts.  Until I had to spend an entire year rebuilding my brain from the ground up.  So much for control.

Lately, I haven't been moody, and I haven't felt sad.  I just feel tired and pointless.  Why put in the effort when past experience tells me that no matter how hard I work, I will fail?  And not just fail, but burn down, fall over, and sink into the swamp?

It would be easier to get off my ass and do something, anything, if I felt like I had any efficacy at all.  But I can't even remember what it feels like to feel a sense of control, to feel like what I do matters, to feel like I can effect the outcome of my own life.  Sure, I can put in the effort, I can work my ass off, but that won't make the Universe take down the "kick me" sign it's had on my back for the last two years.

Maybe if I just lie low, life won't notice me and will leave me alone.

But I can't think like that.  I know I can't.  Because I know that I have to take care of myself, or things will get even worse, and thinking so negatively is bad self care, and is practically a guarantee that things will get worse.  So I need to keep my chin up, stiff upper lip, put on my game face, and all that.  I gotta have heart, right?  Lots and lots and lots of heart!  Gotta keep singing Damn Yankees in my head.

And I guess, for me, for now, that's what success is.  Other people get to feel successful when they land a job, or a promotion, or a raise.  Or when they watch their children sharing a toy on the playground and they think to themselves, hey, I taught them that.  Me?  My success is measured in my ability to talk myself up from the depths of bitter despair, a place where I've landed because, well, my success is measured in my ability to talk myself up from the depths of bitter despair.

Only I can't think like that.  Gotta have heart.  Gotta have heart.  Gotta have heart.

P.S.: Damn Yankees.

No Job for Me!

Remember that new job I was supposed to have?  I should have listened to my brain.  I was just working up to feeling enthusiastic when I got a call from my would-be boss explaining that there was continuing friction between him and his business partner, who doesn't think that having a web presence is important.

Yeah.  Web presence is irrelevant in this day and age.

My would-be boss had been honest about the fact that he and the other owner didn't see eye to eye on a lot of things to the point where working with his business partner tied his stomach up in knots.  He had thought that his partner was agreeing to step back for awhile.  Instead, they may have found someone to buy out my would-be boss.  I can certainly understand why he would decide it's just not worth the stress.

I hate it when my cognitive distortions are right.  I also feel like I'm living in a Russian play or something.  I'm having a hard time not getting completely discourage, not falling into the abyss of "every job is going to fall through, and if it doesn't, it will be abusive and awful -- and then it will fall through".  In a word, #@$^&*!

Cognitive Distortions and Mood. OR: I Have A Job? Meh.

I have a job now.

After a year and a half of unemployment.  After nearly a year of bad, serious crazy.  After learning that my partner is so angry about my crappy work history, my lack of contribution to the household finances, that he can't remember why he loves me.

A job.

It fell into my lap out of the sky.  An acquaintance of ours has decided that he needs his business to have a better web presence.  He's of the pre-internet generation, and he's aware that things like blogging and FaceBook and search engines are important; he's just damned if he knows why or how.  My partner mentioned to him that I had experience in these areas, thinking that this fellow would call me to ask for advice.  Instead, he offered me a job.

The gig is part time, I get to use my brain, I get to work from home, AND I get to create my own schedule.  If I need to sit in front of my sun lamp, I can do that.  If I need to take a meditation break, I can do that.  If I need to listen to Bach, I can do that.  It's not just a job, it's my ideal job.

So why can't I get psyched up about it?

Is Your Therapist Really Helping You Treat Your Mood Disorder?

My sister and I have been having an on-going conversation about therapy.  We've both have mood disorders (her's is depression with severe anxiety disorder) and we've both done tons of therapy.  She also works as an administrator of a chemical dependency program, which has given her a lot of insight into the therapeutic process.

Basically, my sister has noticed that there are huge differences between therapy for chemical dependency and traditional therapy..  The crux of the matter is that therapy for chemical dependency is goal-oriented.  The goal is to get you clean and help you stay clean.  Very specific steps are followed in order to help the client meet this goal.

What is the "goal" of therapy for a mood disorder?  How do you know you've met your goal?  What exactly are you doing to achieve this goal?  As a client, it's pretty hard to figure this out.

Day 47, 100 mgs: Treating Mental Illness Like An Illness

I've mentioned before that I'm taking a class in mindfulness-based cognitive therapy (MCBT) for depression.  We're taught various meditation techniques, which teaches us mindfulness skills, which allows us to be aware of our thoughts, which in turn allows us to recognize thoughts that are depressive, and finally, allows us to release those thoughts.

Last week we talked about caring for ourselves if we relapse.  The hope is that the meditative practice will help to prevent this, but also that it will allow us to notice a relapse before it gets too bad.   It's important to be mindful of the physical and mental symptoms that herald a depressive episode.  Depression, the facilitators explained, tends to follow a pattern in a given individual.  Our homework for the week is to write down what these symptoms are and write up a plan in the event that depression strikes.

This was slightly depressing to me, because in my case, the "usual symptoms" have changed.  Wah!

But a more interesting thought occurred to me: in all my years and years of therapy, none of my mental health care providers ever thought of doing this.  WTF?

Mindfulness CBT: ADHD, Anxiety, Mood, and a Helpful Hack

I've mentioned before that in addition to my crazy, I have ADHD (predominantly inattentive type).  Like a lot of ADD-ers, I've been scared to death of trying meditation.  I've done other spiritual practices, like guided visualizations, or trance work, but meditation "just didn't work for me".

A lot of this has to do with past trauma related to growing up with ADHD.  When you've been shamed your whole life for your failures in attention, anything that sounds like paying attention will raise your defenses.  I'm bad at paying attention.  Everybody always said so, and then I got a diagnosis to prove it.

Since I started taking a class in Mindfulness CBT, I've come to realize something very important -- the only thing required for meditation is that you know how to breathe.

I wish I'd learned this years ago, because I can already tell that meditation is helping me a lot.  It helps even though I don't do it every day like I'm "supposed" to.  I've discovered that I'm calmer after meditation, whether or not I was aware of feeling anxious before.  It lifts my mood if I'm in one of my late-afternoon slumps.  I can't say that it's made me more mindful overall (the goal of the class is to teach us to be mindful in general, so we can recognize our depressive thoughts before they really seize hold of us) but it's definitely helpful in the moment.  And "in the moment" is where you're supposed to be when you meditate anyway.

So how can you possibly meditate when you have ADHD?

Lamictal Day 34: Mood Instability and Depression Due to Variance in Lamotrigine Generics?

Last Friday, day 28, was my first bad day since I started lamictal.  Saturday was my first day at 75 mgs, but I filled my scrip at a different pharmacy, and that meant a different generic manufacturer.  I'd been taking lamotrigine made by Teva for the first four weeks, and now I'm taking NorthStar.  Since then, I feel like I've had many more bad days than good. 

This really feels like a different, less effective medication.  My mood, cognition, and motivation are all suffering.  There have been some days where I've bee unable to get important things done, like cooking dinner or getting scrips filled.  Looking back over the last several days, I'm clearly much less stable than I had been (and I'm not remembering this accurately, which makes me glad I'm keeping this damn blog).  I'm back to my 4 pm crash.

Today, I feel better than I have most days since starting at 75 mgs, but I still feel way lower than I did last week, or any day of the previous 4 weeks.  This sucks incredibly.  I'm trying to just sit with it, let it be what it is, and not get caught up in depressive thoughts. 

Taking Lamictal (or Prozac, or Seroquel, or Whatever)? You Still Have to Deal with Your Shit.

I've recently had conversations with several friends that have me thinking about the way North Americans (and perhaps the English-speaking world in general) have come to define and treat mental illness.

One friend of mine, who has had symptoms of depression for as long as I've known him, is finally considering diagnosis and treatment -- specifically, medication.  He says he has "bad genes".  In his view, I guess, medication will correct the expression of these genes and make him less depressed.

As an example of his "bad genes", he described an incident in which his mother took off for the bar, leaving him sick with the flu and in charge of caring for his two-year-old sister.  Later in the conversation, he made repeated references to his frustration with many of his colleagues, and how he had to "do their work for them".  Hmmm.  Kind of like you had to do your parents' work for them?  How do you feel, by the way, about your mother abandoning you while you were sick?  But he's not interested in therapy.  He just needs help for his "bad genes".

MCBT Homework and ADHD

I'm taking this class in mindfulness-based cognitive behavioral therapy.  I feel like it's helpful -- I certainly feel calmer after meditating -- but on the other hand, the class started just after I began lamictal.  I can't tell what's the drug and what's the meditation.

The class requires homework, and I'm having trouble remembering to do it.  Maybe blogging about it will help.

Day 17: MCBT, Mood, Lamictal, and sleep

I hung out with a friend for awhile today, had lunch, talked of this and that.  She's been on lamictal/lamotrigine for years for bipolar disorder.  It's worked for her, no problems.  It helps to hear that from someone who's actually lived it.

I felt present and engaged, but a little low.  Not depressed, not even sad, just the low side of neutral.  I'm OK with that, I'm just noting it so I know it.  I suspect it's because it was gray and a bit chilly outside.

I accomplished what I feel is my first really "successful" meditation today.  The first meditation we did was  "body scan" version in which the recorded instructions were to take deep breaths ... focus on your breath ... now focus on your right foot ... etc.  That one was done lying down.  The one I did today was a sitting meditation, and seemed to incorporate more general sensory awareness.  The instructions told us to tune in to any sounds I heard, what the cushion under me felt like, whether whether my body was tense, and, of course, my breath.  For some reason, I felt like I had more "permission" than I usually do to watch my thoughts wander away, and then bring them back.

Some Thoughts About MCBT and ADHD

As I've mentioned previously, I'm taking a class in mindfulness-based cognitive behavioral therapy. I've learned a couple of things so far:

1. My mood crashes in the couple of hours before class.  I'm not sure why this is.  Am I thinking about my depression, and how little control I have over it?  Am I thinking about meditation, how hard it is, and how I don't feel like I'm "doing it right"?  Am I thinking about all the homework I've skipped?
2. Meditation is hard.
3. Focusing on my breath, which is supposed to be calming, makes me anxious.  Your heart rate naturally increases when you breathe in, so maybe I'm just interpreting the physiological response as an emotional response?

Day 7 on Lamictal: Mini-meltdown

On Friday (day 7 of my new drug regimen) I had a meltdown that sort of caught me by surprise.

One of my closest friends has returned from a year-long graduate school program on the East Coast.  I missed my friend a lot, and was looking forward to her being a regular part of my life again.  On Friday I learned that she will not be returning home permanently, or at least not yet; she'll be in town for awhile, and then will be driving back to the East Coast for she's-not-sure-how-long.  It's something she strongly feels the need to do.

When I learned this I started crying and couldn't stop.  I'd had an intuition that something was up with my friend.  Now, it had been proven right.  She's leaving.  Like so many of the friends I've made in my adult life, since moving to California ... people just don't seem to stay here.  Everyone abandons me!  Wah!

Lamictal Day 5: Ups and Downs, and Mindfulness CBT

Yesterday was my first really good day.  My mood was in good shape, without my usual low point in the late afternoon.  I don't know how much of this, if any of it, is due to the cup of coffee I had in the morning.  I've learned that it's generally better for me to avoid caffeine, for reasons of both mood and attention, but sometimes when it's right there in the coffee pot ... I just can't help myself.  I had a bit of a headache in the evening, but otherwise no side effects.

Today was not so good.  After starting out in a pretty good place, I was feeling sad by early afternoon.  By late afternoon I was almost weepy.  I felt myself questioning the lamotrigine, wondering if it was going to stop working, or if I was going to have to wait another eight or ten weeks until I reach a "therapeutic" dose.

Things picked up in the evening, when I had my first class in Mindfulness Cognitive Behavioral Training for depression prevention.  After our first meditation exercise, I felt discernibly better. After the second one, I actually felt relaxed and cheerful.  In spite of this, I had another mild headache on my way home from the class (about eight pm or so).  Oh well.

I wish I didn't have to be so concerned about this med.  But when the side effects can include a deadly skin rash or aseptic meningitis, it's hard not to be hypervigilant.